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The arthroscope is a fiberoptic camera that Orthopaedic Surgeons use to examine the inside of joints. It has been in use for many years, primarily in the knee. Over the past ten years the arthroscope has become the surgical method of choice for many shoulder injuries as well. Recently, injuries to additional joints in the body, including the elbow, hip, ankle, and wrist have become increasingly accessible to treatment with the arthroscope.

Over the past few years, wrist arthroscopy has been developed by surgeons with special interest and expertise in hand and wrist injuries. The arthroscope is especially useful in treating certain wrist injuries, since the joint is so small and inaccessible. Previously, the wrist joint had to be opened up to repair any of its structures, and even an open wrist surgery was often unsuccessful, with stiffness, scarring, and persistent symptoms.

The wrist arthroscope is a small tube, several inches in length, but only 2 or 3 millimeters in diameter, that is inserted into the wrist joint. The inside of the joint is then seen on a large television monitor. Using specially designed equipment, the surgery is performed from inside, watching on the monitor. With the wrist joint arthroscope, small ligaments can be repaired without opening up the wrist. Fractures can be reduced and fixed with special equipment. Carpal Tunnel Release surgery, once done only through an open incision in the wrist, can now be performed with the arthroscope, through a quarter inch incision. Many other reconstructive techniques are being continually developed for surgery of the wrist.

Until very recently, there has been no way to reliably repair an injury to the cartilage in your knee. Now there is a new technique that offers patients new hope for an otherwise untreatable problem.

Cartilage is the very smooth, slippery white coating on the ends of your bones (like a cue ball), that cushions the joint, and provides an extremely low friction surface. When that cartilage becomes damaged, it generally does not heal, and slowly continues to break down. This may ultimately result in wearing the cartilage all the way down to bone, resulting in arthritis in the knee.

Previous methods to treat this difficult problem have included a variety of techniques, all designed to fill in the defect in the cartilage with fibrocartilage, a type of scar tissue. Unfortunately, this type of tissue does not have any of the special properties of true cartilage, and typically wears down with time.

Autologous Chondrocyte Implantation, or Carticel, is a technique where your bodies' own cartilage cells are used to repair defects, or holes in the cartilage of your knee. A very small piece of normal healthy cartilage is taken from the knee (with an arthroscopy), and the cells are grown in an outside laboratory to larger quantities. The cells (your own tissue) are then reimplanted back into your knee, into the cartilage defect on the end of your femur (thighbone). Like seeding an area of a lawn, the new cells grow, and fill in the hole in the cartilage!

Arthroscopy (hide)

The arthroscope is a fiberoptic camera that allows the Orthopedic Surgeon to see inside many of the joints in the body, without having to cut those joints open with a large incision. The Arthroscope is a long thin tube, shaped like a straw. They come in various sizes, depending on the size of the joint that is being examined. A camera is attached to the end of the Arthroscope that is outside the body, and this is connected to a television monitor. Thus, one can see the inside of a joint clearly, and magnified many times, on the television monitor in the Operating Room. Often, irrigating fluid is pumped into the joint through the arthroscope cannula, to distend the joint, control any mild bleeding, and improve visualization. Frequently the interested patient can watch along with the rest of us in the Operating Room (only if they want to!)

With the arthroscope, we can now visualize the shoulder, elbow, wrist, hip, knee, and ankle joints. In most cases, the arthroscope gives us an even better picture than if we had to cut open the joint, and is often the only way to visualize certain structures in the body.

During the initial development of the arthroscope, its value was primarily in diagnosis. Now however, many procedures have been developed with arthroscopic techniques, and new arthroscopic instruments have been designed. Often the arthroscopic procedure is superior to the open technique, as there is no need to open a joint and cause additional trauma and scarring. Damaged tissue can be removed or repaired, and many highly sophisticated reconstuctive procedures are performed using the arthroscope.

There are many potential advantages to arthroscopic surgery. In addition to superior visualization, the avoidance of a large incision means less pain, less scarring, and faster healing. Usually only a few tiny puncture wounds are required, and these heal in a few days. This allows earlier motion (when appropriate), and better results.

There are some limitations to arthroscopic surgery, and certainly not every procedure is appropriate for this technique. A well-performed open procedure is always superior to a poorly performed arthroscopic one, and the operating surgeon needs to know his abilities and limitations. There are usually advantages and disadvantages with regards to arthroscopy, and these need to be discussed in detail with your doctor.

Arthroscopic Surgery requires extensive training for the Orthopedic Surgeon. Many courses exist to help surgeons learn new techniques. The Arthroscopy Association of North America is an organization devoted to advancing the arthroscopic knowledge and abilities of its members.

The results of this procedure are extremely encouraging, with marked improvement in over 80 to 90 percent of knees treated. Plus, this type of repair appears to hold up well with time, with results now well over ten years. Our own experience with this technique has been similarly exciting.

Watch or download a short video, showing the inside of a knee both before and after it has been treated with cartilage repair. Check out 'before' and 'after' photos of treated knees.

ACI photos before and after surgery.(hide)

Click here to download RealPlayer G2 if you don't have it.

The meniscus is a c-shaped wedge of tissue in your knee, between the thighbone (femur) and the shinbone (tibia). There are two menisci, medial and lateral, and they function much like gaskets, or shock absorbers, cushioning the knee. They also serve a very important role in lubrication of the knee joint, and aiding in normal knee motion. The meniscus helps to protect the cartilage surface of the knee, and help prevent arthritis.

Cartilage(hide)

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Unfortunately, the meniscus is easily and often torn, and rarely heals on its own. See meniscus tears. Occasionally the torn meniscus can be repaired, but the vast majority of meniscus tears will not heal with surgical repair. Instead, the most common treatment for a torn meniscus is a knee arthroscopy, with trimming out of the torn meniscus fragment. This is usually highly successful, and most patients recover their normal knee function.

Meniscus Tears(hide)

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Sometimes the meniscus sustains a very large tear, and most or all of it must be removed. This leaves the knee with greatly reduced shock absorbency, and increased stress across the knee joint. The knee without a meniscus is at a much higher risk of wearing out the cartilage coating on the end of the knee bones, resulting in painful arthritis, and further surgery.

Until recently, little could be done for the knee that had had most of a meniscus removed, other than limit activity, wait, and hope. Now we have the ability to replace the meniscus with a meniscus transplantation.

The meniscus is replaced with a cadaver meniscus, called an allograft. This donor tissue is thoroughly tested to make sure it is completely free of any disease, and is specifically sized to the recipient patient. The new meniscus is then sutured into the patient's knee, either through an open procedure or arthroscopically, and after a careful rehabilitation, full activities are resumed. Almost all of these meniscus transplantations heal with few, if any problems. The long term results remain to be seen, but the early results are quite exciting!

Arthroscopy (hide)

The arthroscope is a fiberoptic camera that allows the Orthopedic Surgeon to see inside many of the joints in the body, without having to cut those joints open with a large incision. The Arthroscope is a long thin tube, shaped like a straw. They come in various sizes, depending on the size of the joint that is being examined. A camera is attached to the end of the Arthroscope that is outside the body, and this is connected to a television monitor. Thus, one can see the inside of a joint clearly, and magnified many times, on the television monitor in the Operating Room. Often, irrigating fluid is pumped into the joint through the arthroscope cannula, to distend the joint, control any mild bleeding, and improve visualization. Frequently the interested patient can watch along with the rest of us in the Operating Room (only if they want to!)

With the arthroscope, we can now visualize the shoulder, elbow, wrist, hip, knee, and ankle joints. In most cases, the arthroscope gives us an even better picture than if we had to cut open the joint, and is often the only way to visualize certain structures in the body.

During the initial development of the arthroscope, its value was primarily in diagnosis. Now however, many procedures have been developed with arthroscopic techniques, and new arthroscopic instruments have been designed. Often the arthroscopic procedure is superior to the open technique, as there is no need to open a joint and cause additional trauma and scarring. Damaged tissue can be removed or repaired, and many highly sophisticated reconstuctive procedures are performed using the arthroscope.

There are many potential advantages to arthroscopic surgery. In addition to superior visualization, the avoidance of a large incision means less pain, less scarring, and faster healing. Usually only a few tiny puncture wounds are required, and these heal in a few days. This allows earlier motion (when appropriate), and better results.

There are some limitations to arthroscopic surgery, and certainly not every procedure is appropriate for this technique. A well-performed open procedure is always superior to a poorly performed arthroscopic one, and the operating surgeon needs to know his abilities and limitations. There are usually advantages and disadvantages with regards to arthroscopy, and these need to be discussed in detail with your doctor.

Arthroscopic Surgery requires extensive training for the Orthopedic Surgeon. Many courses exist to help surgeons learn new techniques. The Arthroscopy Association of North America is an organization devoted to advancing the arthroscopic knowledge and abilities of its members.